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Journal and News Scan

Source: Circulation Research
Author(s): Laura A Bienvenu, Ana Maluenda, James D McFadyen, Amy Kate Searle, Eefang Yu, Carolyn Haller, Elliot L Chaikof, Karlheinz Peter, Xiaowei Wang

A review that may affect pharma strategy in the immediate future.

Source: Journal of Thoracic and Cardiovascular Surgery
Author(s): Niv Ad, Jessica G Y Luc, Tom C Nguyen, COVID-19 North American Cardiac Surgery Survey Working Group

The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.

Source: The Annals of Thoracic Surgery
Author(s): Takashi Miura, Kikuko Obase, Tsuneo Ariyoshi, Ichiro Matsumaru, Shogo Yokose, Shun Nakaji, Yuichi Tasaki, MD, Takashi Shimada, Junya Miyamoto, Kiyoyuki Eishi

This single-institution study of 83 patients investigated mitral valve repair for infective endocarditis based on the location of the lesion. 

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Josephina Haunschild, Konstantin von Aspern, Zara Khachatryan, Edoardo Bianchi, Till Friedheim, Sabine Wipper, Constantin J Trepte, Susann Ossmann, Michael A Borger, Christian D Etz

Haunschild et al. investigated the effect of cerebrospinal fluid pressure elevation on spinal cord perfusion in a large animal model. They could measure spinal cord perfusion by NIRS and microsphere injections. The spinal perfusion was significantly diminished during elevated cerebrospinal fluid pressure. Furthermore, rapid withdrawal of cerebrospinal fluid was associated with hyperperfusion, which might lead to aggravated ischemia-reperfusion injury and should therefore be avoided.

Source: The Journal of Thoracic and Cardiovascular Surgery
Author(s): Tirone E. David, MD; Carolyn M. David, BN; Myriam Lafreniere-Roula, PhD; Cedric Manlhiot, PhD

David et al. examined the durability of mitral repair using using chordal replacement with expanded polytetrafluoroethylene sutures to correct leaflet prolapse.They evaluated 186 patients who underwent isolated chordal replacement, and 560 patients who underwent both leaflet resection and choral replacement.

The authors demonstrated that re-do cardiac surgery and isolated anterior leaflet prolapse resulted in an increased hazard of mitral valve reoperation. The probability of recurrent moderate or severe mitral regurgitation using repeated measures regression models was 14.1% at 20 years. Variables associated with recurrent MR in multivariable regression analysis were left ventricular ejection <40% and preoperative complete heart block. 
David et al. note that chordal replacement with expanded polytetrafluoroethylene sutures provides stable mitral valve function in most patients during the 20 years of follow-up.


Source: European Journal of Cardio-Thoracic Surgery
Author(s): Bettina Pfannmueller, Martin Misfeld, Alexander Verevkin, Jens Garbade, David M Holzhey, Piroze Davierwala, Joerg Seeburger, Thilo Noack, Michael A Borger

The study compared long-term results of loop neochord replacement with leaflet resection techniques in 2134 patients undergoing minimally invasive mitral valve repair.
They demonstrated a significant reduction in early mitral regurgitation with the loop technique (on echocardiographyl; p=0.003) when compared with leaflet resection. Additionally, the long-term outcomes were excellent compared with classical leaflet resection techniques (the 1-, 5- and 10-year survival rates were 98 ± 1%, 95 ± 1% and 86 ± 2% for the loop technique versus 97 ± 1%, 92 ± 1% and 81 ± 2% for resection patients, respectively (P = 0.003).

Source: The Annals of Thoracic Surgery
Author(s): George Kuo, Shao-Wei Chen, Cheng-Chia Lee, Jia-Jin Chen, Pei-Chun Fan, Shang-Yu Wang, Ya-Chung Tian, Chih-Hsiang Chang

This study investigated fluit overload in cardiac and aortic surgery patients.

Source: Interactive CardioVascular and Thoracic Surgery
Author(s): Anne L M Goedhart, Bastiaan M Gerritse, Thijs C D Rettig, Martijn W A van Geldorp, Sander Bramer, Nardo J M van der Meer, Leandra J Boonman-de Winter, Thierry V Scohy

Goedhart et al. investigated the effect of different heparin/protamine ratios on the amount of blood transfusions following standard cardiac surgery. In the group of patients receiving 0.6/1 protamine/heparin ratio, the fraction of patients without the need of transfusion was higher and the total blood loss was lower compared to patients treated with a 0.8/1 protamine/heparin ratio. In their patient collective, the 0.6/1 protamine/ heparin ratio proved safe and superior.

Source: European Journal of Cardio-Thoracic Surgery
Author(s): Ali Hage, Louis-Mathieu Stevens, Maral Ouzounian, Jennifer Chung, Ismail El-Hamamsy, Vincent Chauvette, Francois Dagenais, Andreanne Cartier, Mark D Peterson, Munir Boodhwani, Ming Guo, John Bozinovski, Michael C Moon, Abigail White, Kanwal Kumar, Carly Lodewyks, Bindu Bittira, Darrin Payne, Michael W A Chu on behalf of the Canadian Thoracic Aortic Collaborative

This manuscript by Hage et al. retrospectively looks into the outcome of more than 2500 patients undergoing aortic arch replacement within the Canadian Thoracic Aortic Collaborative registry. They analyzed risk factors for mortality and stroke. Antegrade perfusion and perfusion at temperatures higher than 24°C were independent predictors of favorable outcomes. This data should encourage aortic surgeons to execute antegrade perfusion strategies and warmer temperature regimes during circulatory arrest for arch surgery.

Source: The Annals of Thoracic Surgery
Author(s): Alexander P. Nissen, MD, Charles C. Miller III, PhD, Vinod H. Thourani, MD, Y. Joseph Woo, MD, James S. Gammie, MD, Gorav Ailawadi, MD, Tom C. Nguyen, MD

There is controversy in the role of less invasive mitral surgery (LIMS) in treating complex mitral pathology.  This study uses the STS National Database to compare LIMS vs. sternotomy stratified by pathology in 41,082 patients.  The authors found that repair rates were higher with LIMS irrespective of mitral pathology.  Stroke rates, atrial fibrillation, pacemaker, renal failure, and length of stay were also shorter with LIMS.